Three-Dimensional High-Resolution Magnetic Resonance Imaging for the Assessment of Cervical Artery Dissection

Abstract

Background and PurposeDiagnosing cervical artery dissection (CAD) is still a challenge based on the current radiographic criteria. This study aimed to assess the value of three-dimensional high-resolution magnetic resonance imaging (3D HRMRI) in the detection of the signs of CAD and its diagnosis.Materials and MethodsPatients with CAD from January 2016 to January 2021 were recruited from our 3D HRMRI database. The signs of dissection (intramural hematomas, intimal flap, double lumen), length and location of the dissection, thickness of the intramural hematoma, intraluminal thrombus, and percentage of dilation of the outer contour of the dissection on 3D HRMRI were assessed.ResultsFourteen patients with 16 CADs, including 12 carotid CADs and 4 vertebral CADs, were finally diagnosed in this study. On 3D HRMRI, intramural hematomas were detected in 13/16 (81.3%) lesions with high sensitivity (100%) and high specificity (100%). Intimal flaps were found in 9/16 (56.3%) lesions with moderate sensitivity (64.3%) and high specificity (88.9%). Double lumen signs were observed in 4/16 (25.0%) lesions with high sensitivity (80.0%) and high specificity (100%). In addition, concomitant intraluminal thrombus were detected in 4/16 (25.0%) lesions with high sensitivity (80.0%) and high specificity (100%). The mean length of dissection was (25.1 ± 13.7) mm. The mean thickness of the intramural hematoma was (4.3 ± 2.3) mm. The mean percentage of dilation for the outer contour of the dissection was (151.3 ± 28.6)%.ConclusionThe 3D HRMRI enables detection of the dissecting signs, such as intramural hematoma, intimal flap, double lumen, and intraluminal thrombus with high sensitivity and specificity, suggesting a useful, and non-invasive tool for definitively diagnosing CAD.

Studying the imaging features and infarction mechanism of vertebrobasilar dolichoectasia with high‐resolution magnetic resonance imaging

“…Dolichoectasia is diagnosed if the BA bifurcation height or BA laterality was ≥2 [ 11 ]. Cerebral artery dissection is defined as blood components entering the vessel wall through the damaged intima for various reasons, leading to the dissection and stratification of the vascular walls, which can manifest as a double lumen, intima flap, intramural hematoma, and other signs on imaging [ 8 , 12 ]. The BA wall of patients with VBD was divided into two sides: the vessel wall near the lateral side was defined as the greater curvature side and the vessel wall near the medial side was defined as the lesser curvature side, as shown in Figure 1 .…”

“…High‐resolution magnetic resonance imaging (HR‐MRI) has been proven to be an effective method for evaluating the morphology and composition of arterial wall lesions. It has been widely used in the diagnosis and evaluation of intracranial atherosclerotic disease, intracranial artery dissection, moyamoya disease, and carotid web [ 7 , 8 , 9 ]. Here, we retrospectively analyzed the imaging characteristics of HR‐MRI in patients with VBD to explore the possible mechanism of IS.…”

Post-Traumatic Cerebral Infarction: A Narrative Review of Pathophysiology, Diagnosis, and Treatment

“…It may be especially useful in evaluating arterial dissection and venous thrombosis. The diagnostic value in arterial dissection has been demonstrated in both cervical and intracranial arteries [ 65 , 66 , 67 ]. Classic MR VWI presentations of dissection include the presence of a double lumen, “string” sign, or a crescent-shaped intramural hematoma.…”